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Patients with peripheral artery disease (PAD) who participated in a guideline-based program designed to lower cardiometabolic risk suffered significantly fewer heart attacks, strokes, and amputations compared with patients who did not participate in the program, during up to 7-year follow-up.

Patients with peripheral artery disease (PAD) who participated in a guideline-based program designed to lower cardiometabolic risk suffered significantly fewer heart attacks, strokes, and amputations compared with patients who did not participate in the program, researchers reported.

Over up to 7 years of follow-up, patients who took part in the program targeting eight key risk-reduction therapies had a 37% relative reduction in cardiovascular events (death, acute myocardial infarction, or ischemic stroke) and a 53% reduction in major amputations and arterial bypass.

Results from the observational, cohort study suggest that guideline-based educational intervention targeting cardiometabolic risk can improve long-term outcomes in patients with PAD, wrote researcher Thomas Lindsay, MDCM, of Toronto General Hospital, and colleagues in JAMA Surgery, published online April 6.

"Cardiologists are fastidious about treating these risk factors in patients who have had myocardial infarctions, but they may not be on the radar of clinicians treating patients with PAD," Lindsay told MedPage Today. "The message to vascular surgeons and family doctors is that these risk factors need to be aggressively treated in their patients with peripheral artery disease."

"Benefits of individual pharmacotherapies in reducing the risk of cardiovascular events in patients with PAD have been reported in previous studies; however, to our knowledge, no study had examined the effect of a program that focuses on all eight guideline-recommended risk-reduction therapies," the researchers wrote.

They developed the Systematic Assessment of Vascular Risk (SAVR) program in an effort to provide comprehensive risk management to patients with PAD. They compared long-term outcomes among 290 PAD patients who participated in the SAVR program and 501 who did not who were treated at tertiary centers not enrolled in the program.

SAVR program participants received in-clinic education about PAD, their specific risk factors and management strategies to reduce their risks. Risk factors were addressed with pharmacotherapy and referral to appropriate specialists.

General practitioners and other clinicians caring for patients in the program also received written materials on clinical practice guidelines for PAD risk management.

The mean age of patients in the SAVR group was 67.9 (10.4) years, compared with 68.2 (11.2) years in the control group. The primary study outcome was composite risk ratio of death, acute MI, or ischemic stroke. Secondary outcomes included lower limb amputation rate, bypass surgical procedures, and peripheral angioplasties with and without a stent.

Patients were followed for up to 7 years, and the analysis revealed that:

During follow-up, the SAVR group experienced the primary outcome at a significantly lower rate than the control group (adjusted hazard ratio [HR], 0.63; 95% CI, 0.52-0.77).

The rate of peripheral angioplasty with or without a stent was higher among the SAVR group (adjusted HR, 2.97; 95% CI 2.15-4.10).

A study limitation cited by the researchers included the possibility of residual confounding, which may have biased the results, despite propensity-score matching. They also noted that low coding accuracy was a possible source of bias and that just 65% of patients in the SAVR group were matched with control patients.

In an editorial published with the study, William Robinson, MD, and Gilbert Upchurch, Jr., MD, of the University of Virginia, Charlottesville, wrote that these and other study limitations make it difficult to assess the intervention's impact on outcomes.

They noted that since enrollment in the program was voluntary, the SAVR group may have included more motivated patients who were likely to have better outcomes independent of their participation in the program.

The reliance on administrative data to identify a control group and outcomes in both the SAVR and control groups also made the identification of the severity of PAD difficult, they wrote.

"Despite the propensity matching, it is thus unclear whether the two cohorts are comparable in terms of severity of PAD," they wrote. "The finding that the control group underwent more arterial bypasses and amputations and that the SAVR cohort underwent more endovascular interventions (which are generally performed for more limited anatomic disease) heightens this suspicion."

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